Characteristics and Long-Term Ablation Outcomes of Supraventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 10-Year, Single-Center Experience

Abstract

Background: A variety of supraventricular arrhythmias (SVAs) may occur in patients with hypertrophic cardiomyopathy (HCM). The characteristics and long-term ablation outcomes of different types of SVAs in HCM have not been comprehensively investigated.Methods: We retrospectively enrolled 101 consecutive patients with HCM who were referred to the electrophysiology and arrhythmia service from May 2010 to October 2020. The clinical features and ablation outcomes were analyzed.Results: Seventy-eight patients had SVAs, which comprised 50 (64.1%) cases of atrial fibrillation (AF), 16 (20.5%) of atrial flutter (AFL), 15 (19.2%) of atrioventricular reentrant tachycardia (AVRT), 11 (14.1%) of atrial arrhythmia (AT), and 3 (3.8%) of atrioventricular nodal reentrant tachycardia (AVNRT). Thirty-four patients underwent catheter ablation and were followed up for a median (interquartile range) of 58.5 (82.9) months. There was no recurrence in patients with non-AF SVAs. In patients with AF, the 1- and 7-year AF-free survival rates were 87.5 and 49.5%, respectively. A receiver operator characteristic analysis showed that a greater left ventricular end-diastolic dimension (LVEDD) was associated with a higher recurrence of AF, with an optimum cutoff value of 47 mm (c-statistic = 0.91, p = 0.011, sensitivity = 1.00, specificity = 0.82). In Kaplan–Meier analysis, patients with a LVEDD ≥ 47 mm had worse AF-free survival than those with a LVEDD <47 mm (log-rank p = 0.014).Conclusions: In this unique population of HCM, AF was the most common SVA, followed in order by AFL, AVRT, AT, and AVNRT. The long-term catheter ablation outcome for non-AF SVAs in HCM is satisfactory. A greater LVEDD predicts AF recurrence after catheter ablation in patients with HCM.

Commentary: Characteristics and Long-Term Ablation Outcomes of Supraventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 10-Year, Single-Center Experience

“…Secondly, as described in the original manuscript, Figure 3B shows that “In Kaplan-Meier analysis, patients with a LVEDD ≥ 47 mm had a worse AF-free survival than those with a LVEDD <47 mm (log-rank p = 0.014) ( 1 )”. As the Figure 3B shows that of the 16 patients who had AF ablation, although, the cumulative AF-free survival in the subgroup with LVEDD <47 mm is a straight line, which means that the subgroup does not appear to have experienced any events during the follow-up period, the corresponding Number at risk, at the bottom of the Figure 3B, in LVEDD <47 mm subgroup does not match to the straight line.…”

“…This paper is a commentary on the article "Characteristics and Long-Term Ablation Outcomes of Supraventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 10-Year, Single-Center Experience (1)." The authors aimed to identify a cut-off value of left ventricular end-diastolic dimension (LVEDD) to predict atrial fibrillation (AF) recurrence after catheter ablation in patients with hypertrophic cardiomyopathy (HCM).…”

“…This paper is a commentary on the article “Characteristics and Long-Term Ablation Outcomes of Supraventricular Arrhythmias in Hypertrophic Cardiomyopathy: A 10-Year, Single-Center Experience ( 1 ).” The authors aimed to identify a cut-off value of left ventricular end-diastolic dimension (LVEDD) to predict atrial fibrillation (AF) recurrence after catheter ablation in patients with hypertrophic cardiomyopathy (HCM). However, there are inconsistencies between Figures 3A,B in numbers at risk, as well as, between the Kaplan-Meier curve and corresponding numbers at risk in the Figure 3B in the original manuscript.…”

Characteristics of Primary Bradyarrhythmia in Hypertrophic Cardiomyopathy: A 10-Year, Single-Center Analysis

“…Patients with hypertrophic cardiomyopathy (HCM) often experience different kinds of arrhythmias, including both tachyarrhythmias and bradyarrhythmias [1,2]. Atrial fibrillation is the most common, and ventricular fibrillation is the most fatal arrhythmia in HCM, and they have been extensively investigated [1][2][3][4]. Symptomatic bradycardia caused by sinus node dysfunction (SND) and atrioventricular block (AVB) is relatively uncommon in HCM [2].…”